Antithrombotic Therapy Practices in US Hospitals in an Era of Practice Guidelines

Tapson, Victor F.

doi:10.1001/archinte.165.13.1458

Cited by 147 publications

(108 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…19,20 The results of a large postal survey of orthopaedic surgeons showed only 42% prescribe an extended duration of VTE prophylaxis beyond discharge, nearly all of which use aspirin. 21 However, the use of aspirin for extended VTE prophylaxis is now questioned since the Pulmonary Embolism Prevention (PEP) study of over 4000 total hip and knee replacements concluded that aspirin provides no benefit over placebo, whilst the 160 mg dosage has an associated significant risk of gastrointestinal bleeding.…”

Section: Discussionmentioning

confidence: 99%

Is there adequate provision of venous thrombo-embolism prophylaxis following hip arthroplasty? An audit and international survey

Rogers

Phillips

Foote

et al. 2010

annals

View full text Add to dashboard Cite

INTRODUCTIONThe peak incidence of venous thrombo-embolism (VTE) occurs 3 weeks following hip arthroplasty surgery and current guidelines proposing VTE prophylaxis continuing for 4 weeks after surgery. This study first compares the duration of treatment and satisfaction between patients prescribed low molecular weight heparin (LMWH) and rivaroxaban, a new oral Factor Xa inhibitor, following elective hip arthroplasty; and second, surveys the duration of LMWH use in other units. SUBJECTS AND METHODS An international survey detailing the use of LMWH was performed. A prospective audit was performed of 100 hip replacements, with 50 prescribed 40 mg once daily of subcutaneous enoxaparin and subsequently 50 patients prescribed 10 mg once daily of oral rivaroxaban. The duration of treatment, patient satisfaction and complications for both cohorts was quantified and compared against published evidence-based guidelines. RESULTS The survey demonstrated that four out of 39 (10.2%) units that routinely prescribe LMWH do so for at least 4 weeks following surgery. The audit demonstrated that rivaroxaban afforded a superior mean duration of postoperative VTE prophylaxis (35 days vs 5.4 days; P < 0.05) and superior patient satisfaction. There was no difference in the incidence of bleeding, wound infection or thrombotic complications. CONCLUSIONS This study demonstrates that patients are exposed to an increased VTE risk following hip replacement surgery due to the inadequate prescription of LMWH. This is poor clinical practice, contrary to current evidence-based guidelines and has potential medicolegal implications. The prescription of rivaroxaban affords a superior patient compliance compared with subcutaneous LMWH, thus ensuring that patients receive VTE prophylaxis for the current recommend period of time.

show abstract

Section: Discussionmentioning

confidence: 99%

Is there adequate provision of venous thrombo-embolism prophylaxis following hip arthroplasty? An audit and international survey

Rogers

Phillips

Foote

et al. 2010

annals

View full text Add to dashboard Cite

show abstract

“…The scientific literature has largely focused on the need of thromboembolic prophylaxis, providing efficacy evidence, when performed in the manner and appropriate times [10,11].…”

Section: Medical Liability In Prevention Diagnosis and Treatment Ofmentioning

confidence: 99%

Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications

Vassalini

Verzeletti

Ferrari

2016

Monaldi Arch Chest Dis

View full text Add to dashboard Cite

Parole chiave: Linee guida; tromboembolismo venoso; responsabilità professionale; medicina difensiva. Key words: Guidelines; venous thromboembolism; medical malpractice. Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implicationsLinee guida e buone pratiche accreditate nella prevenzione e diagnosi del tromboembolismo venoso: profili di responsabilità professionale AbstractConcerning recent Italian laws and jurisprudential statements, guidelines application involves several difficulties in clinical practice, regarding prevention, diagnosis and therapy of venous thromboembolism. International scientific community systematically developed statements about this disease in order to optimize the available resources in prophylaxis, diagnosis and therapy. Incongruous prevention, missed or delayed diagnosis and/or inadequate treatment of this disease can frequently give rise to medico-legal litigation. RiassuntoL'applicazione in ambito clinico delle linee guida e buone pratiche accreditate, alla luce delle recenti pronunce legislative e giurisprudenziali, presenta molteplici criticità, con particolare riferimento alla prevenzione, diagnosi e cura del tromboembolismo venoso. A fronte della complessità del fenomeno, della difficoltà di gestione, dei costi correlati alla conseguente morbilità e mortalità di tale entità clinica la comunità scientifica internazionale ha cercato di delineare delle regole di condotta universalmente condivise al fine di ottimizzare le risorse disponibili nella fase di prevenzione e gestione diagnostico-terapeutica. Al contempo, sempre più frequentemente vengono paventate ipotesi di responsabilità professionale per incongrua profilassi, mancata o ritardata diagnosi e/o insoddisfacente terapia del tromboembolismo venoso.

show abstract

“…34 It has an immediate onset of action after intravenous administration and a short half-life (25 minutes in patients with normal renal function). 35 Bivalirudin alone and in combination with a GP IIb/IIIa inhibitor were compared with heparin (UFH or enoxaparin) plus a GP IIb/IIIa inhibitor in the ACUITY study, a randomized, controlled, noninferiority study of more than 13,000 patients with NSTEMI scheduled to undergo angiography. 36 Most patients received clopidogrel.…”

Section: Anticoagulant Therapiesmentioning

confidence: 99%

“…35 Overlap of parenteral and oral anticoagulant therapies was appropriate in 246 (51%) of the 486 patients who received overlapping therapies. Most patients were not discharged from the hospital until after parenteral therapy was discontinued.…”

Section: ■■ Vte Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Applying Quality Measures and Guidelines in the Management of Acute Coronary Syndrome and Venous Thromboembolism

Gulseth

Sobieszczyk²,

Fanikos³

et al. 2008

JMCP

View full text Add to dashboard Cite

Antithrombotic Therapy Practices in US Hospitals in an Era of Practice Guidelines

Abstract: A significant percentage of hospitalized patients do not receive adequate antithrombotic therapy for the primary and secondary prevention of thromboembolic disease.

Cited by 147 publications

References 43 publications

Is there adequate provision of venous thrombo-embolism prophylaxis following hip arthroplasty? An audit and international survey

Is there adequate provision of venous thrombo-embolism prophylaxis following hip arthroplasty? An audit and international survey

Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications

Applying Quality Measures and Guidelines in the Management of Acute Coronary Syndrome and Venous Thromboembolism

Contact Info

Product

Resources

About